基于染料的 chromoendoscopy 用于结直肠肿瘤的检测：随机对照试验的荟萃分析。
Dye-based chromoendoscopy for the detection of colorectal neoplasia: meta-analysis of randomized controlled trials.
机构信息
Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy; Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome, Rome, Italy.
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.
出版信息
Gastrointest Endosc. 2022 Sep;96(3):411-422. doi: 10.1016/j.gie.2022.05.002. Epub 2022 May 16.
BACKGROUND AND AIMS
Dye-based chromoendoscopy (DBC) could be effective in increasing the adenoma detection rate (ADR) in patients undergoing colonoscopy, but the technique is time-consuming and its uptake is limited. We aimed to assess the effect of DBC on ADR based on available randomized controlled trials (RCTs).
METHODS
Four databases were searched up to April 2022 for RCTs comparing DBC with conventional colonoscopy (CC) in terms of ADR, advanced ADR, and sessile serrated adenoma detection rate as well as the mean adenomas per patient and non-neoplastic lesions. Relative risk (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes were calculated using random-effect models. The I test was used for quantifying heterogeneity. Risk of bias was evaluated with the Cochrane tool.
RESULTS
Overall, 10 RCTs (5334 patients) were included. Indication for colonoscopy was screening or surveillance (3 studies) and mixed (7 studies). Pooled ADR was higher in the DBC group versus the CC group (95% CI, 48.1% [41.4%-54.8%] vs 39.3% [33.5%-46.4%]; RR, 1.20 [1.11-1.29]), with low heterogeneity (I = 29%). This effect was consistent for advanced ADR (RR, 1.21 [1.03-1.42]; I = .0%), sessile serrated adenomas (6.1% vs 3.5%; RR, 1.68 [1.15-2.47]; I = 9.8%), and mean adenomas per patient (MD, .24 [.17-.31]) overall and in the right-sided colon (MD, .28 [.14-.43]). A subgroup analysis considering only trials using high-definition white-light endoscopy reduced the heterogeneity while still showing a significant increase in adenoma detection with DBC: 51.6% (95% confidence interval [CI], 47.1%-56.1%) and 59.1% (95% CI, 54.7-63.3%), RR = 1.14 (95% CI, 1.06-1.23), P = .0004, I = .0%, P = .50.
CONCLUSIONS
Meta-analysis of RCTs showed that DBC increases key quality parameters in colonoscopy, supporting its use in everyday clinical practice.
背景与目的
基于染料的 chromoendoscopy（DBC）可有效提高接受结肠镜检查患者的腺瘤检出率（ADR），但该技术耗时且采用受限。我们旨在根据现有的随机对照试验（RCT）评估 DBC 对 ADR 的影响。
方法
截至 2022 年 4 月，我们在四个数据库中搜索了比较 DBC 与常规结肠镜检查（CC）在 ADR、高级 ADR、无蒂锯齿状腺瘤检出率以及每位患者平均腺瘤数和非肿瘤性病变方面的 RCT。使用随机效应模型计算二分类结局的相对风险（RR）和连续结局的平均差异（MD）。使用 I 检验来量化异质性。使用 Cochrane 工具评估偏倚风险。
结果
总共纳入了 10 项 RCT（5334 例患者）。结肠镜检查的适应证为筛查或监测（3 项研究）和混合（7 项研究）。DBC 组的 ADR 高于 CC 组（95%CI，48.1%[41.4%-54.8%] vs 39.3%[33.5%-46.4%]；RR，1.20[1.11-1.29]），异质性较低（I = 29%）。对于高级 ADR（RR，1.21[1.03-1.42]；I =.005）、无蒂锯齿状腺瘤（6.1% vs 3.5%；RR，1.68[1.15-2.47]；I = 9.8%）和每位患者的平均腺瘤数（MD，.24[.17-.31]），总体和右侧结肠（MD，.28[.14-.43]），这种效果都是一致的。考虑仅使用高清白光内镜进行的试验的亚组分析减少了异质性，但仍显示 DBC 可显著增加腺瘤检出率：51.6%（95%置信区间[CI]，47.1%-56.1%）和 59.1%（95% CI，54.7%-63.3%），RR = 1.14（95% CI，1.06-1.23），P =.0004，I =.0%，P =.50。
结论
RCT 的荟萃分析表明，DBC 提高了结肠镜检查的关键质量参数，支持其在日常临床实践中的应用。
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